The URL can be used to link to this page

EL-05-235 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(.305)795.224 41jag;_,(305)756.8972 BUILDING �-0 ~ Z� Permit No. r . PERMIT APPLICATION Master Permit No. FBC 2001 .-. Permit Type(circle): Building �ctrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) I1 1 o Phone# (�� 1 Q q 2. " 2G 3CP Owner's Address , City l�wL t S{io G:$ State �-C— Zip13-2 Tenant/Lessee Name Phone# Job Address(where the work is being done) 3-7V- M 6 . 9 L � City Miami Shores Villa e County Miami-Dade Zip 33 Is Building Historically Designated YES NO Contractor's Company Name �� Phone# Contractor's Address City State Zip Qualifier t State Certificate or Registration No. C ate of Competency No. Architect/Engineer's Name(if applicable) Phone# $Value of Work For this Permit Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition - p Describe Work: ri Submittal Fee$ Permit Fee$ �� ''" CCF$ 0• G 0 CO/CC Notary$ Trainin /Education Fee$ .Z� CJ Technology •50 Training/Education ogy Fee$ Z Scanning$ :3�0 Radon$ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Total Fee Now Due$ I f 30 (Continued on opposite side) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fe&will be charged. Signature "ASignature er or Agent Contragor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 114 4 20 a�,by day of 20_,by who is personally known to me or who has produced w who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY P : NOTARY PUBLIC: Sign: UBLICSign: a c enelus Print: i `= D329574 Print: M Commission Expires: /�6 I ;. Expires:Jun 16 2008 My p ( !U ,'�•• •c`�� BondedThni My Commission Expires: L%�" APPLICATION APPROVED BY: /3J� LSV Plans Examiner Engineer Zoning chc 05/13/03 ADDENDUM TO BUILDING PERMIT APPLICATION (,tql APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. ) PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIRA ETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS QVER 1- 3 HP HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER - 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS I HEATER-NEW INST. GENERATORS TRANSFORMERS HEATER-REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER-WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER NNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY-WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING i VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMENT being the legal property yowner for the property A Located at:V`7 y N.C. q � M� cx.ali Stares -C , 3313-9 Legally described as , Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,F.S.489.103(7), end I have read and understand the following disclosure Statement, which entitles me to arork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATETNMNT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one-family or two-family residence or a farm out-building. f You may also build or improve a commercial building at a cost of 525,000.00 or less.The building must be for your own use and occupancy.It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor.It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with-holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances,building codes and zoning regulations. Proof of ownership provided( ) initial of reviewing clerk. The foregoing instrument Was acknowledged before me this ( _day f200Y By who itpers lly known to me or who has Produced as identification and who did take an oath % Mabe Argas Milli ►011 IM231984 :Ju 3,2007 ru '-Owner otary .t c in,(,0 s;); Owner